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Lottie's DPD 2 > Arthritis > Flashcards

Arthritis Flashcards

1
Q

What do you need to ask about in HPC?

A 
Age and sex 
Joints - large / small / spine / sacral 
Long / gradual or sudden /acute 
Is pain better or worse on movement?
Is stiffness worse in morning / after rest? 
Swelling?
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2
Q

What PMH/FH Qs are relevant to arthritis?

A

Arthritis
AID - hypothyroidism or T1DM
Inflam conditions - psoriasis, iritis, IBD

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3
Q

What SH Qs do you need to ask for arthritis?

A

Occupation - effect of symptoms on job

Smoking

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4
Q

What do you look for O/E of joints?

A

INSPECTION = Which joints? Swelling / rash / nail changes
PALPATION = temperature, tenderness, swelling - bony/soft?
MOVEMENT = range of movement, pain/crepitus on movement
Contrast active vs passive

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5
Q

Which type of movement mainly tests bones and not tendons?

A

Passive

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6
Q

List types of arthritis

A

Osteoarthritis
Rheumatoid
Crystal
Spondyloarthritis

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7
Q

What % of adults have osteoarthritis?

A

10%

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8
Q

Which joints do osteoarthritis affect?

A

Base & ends of thumbs, DIPJ, PIPJ

Hips, knees

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9
Q

List 3 components of osteoarthritis

A

Cartilage degradation
New bone formation - osteophytes
Inflammation - synovitis / effusion

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10
Q

What is PC of osteoarthritis?

A

Gradual
Pain on weight bearing joints
Stiffness for 30 mins
Swelling

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11
Q

List classic deformities of osteoarthritis

A

Heberdens nodes = DIPJ
Bouchards nodes = PIPJ
Squaring of thumb base
Varus at knee - medial cartilage wearing away

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12
Q

List XR changes of osteoarthritis

A

Loss of joint space
Subchondral sclerosis (thickening)
Cysts
Osteophytes

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13
Q

What is Mx of osteoarthritis ?

A

No disease modifying drugs
Education & physio
Pain relief

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14
Q

Pathophysiology of gout?

A

XS uric acid deposition

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15
Q

Where does uric acid come from?

A

Purine metabolism

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16
Q

Describe the uric acid crystals

A

Needle shaped negatively birefringent crystals

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17
Q

PC of gout

A

1st MTP in toe
Short, acute, VERY painful and stiff and swollen
+/- tophi

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18
Q

Ix for gout?

A

BLOODS: urate, CRP, ESR

XR of area

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19
Q

What will XR of gout show?

A 
Early = nothing 
Late = rat bite erosions at side of bone
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20
Q

Mx of gout?

A

NSAIDs or colchicine (acute)

dietary advice +/- allopurinol (long term)

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21
Q

What enzyme metabolises purine?

A

Xanthine oxidase

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22
Q

What should be avoided in low purine diet?

A

BEER
Fish eg anchovies, mackerels
Game
Spinach, cauliflower, lentils, asparagus

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23
Q

What is a contraindication to allopurinol?

A

Azathioprine

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24
Q

What is pseudo gout?

A

Calcium pyrophosphate deposition

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25
Q

Shape of pseudo gout crystals?

A

positively birefringent rhomboids

26
Q

To whom & where does pseudo gout occur?

A

Knees and wrists

Older females

27
Q

What is the hallmark of RA?

A

Synovial inflammation

28
Q

List polymorphisms that can lead to RA

A

HLA class 2 eg DR4 and DR1

29
Q

What AB is present in RA?

A

Anti CCP

30
Q

Is rheumatoid factor IgG or IgM?

A

IgM

31
Q

PC of RA?

A 
Polyarticular small joint stiffness 
Morning and post-rest stiffness 
Joint swelling 
FH of RA or AID 
Smoking is a risk factor
32
Q

Who does RA affect?

A

40-50y/o females

33
Q

Which joint is involved in RA?

A

MPJs

34
Q

O/E RA?

A

Soft swelling

Painful on movement

35
Q

Signs of uncontrolled RA?

A 
Swan neck deformities 
Boutonnieres 
Z thumb 
Ulnar deviation at MCPs 
Wrist subluxation
36
Q

Other signs outside of RA hands?

A

Atlanto-axial subluxation

Synovitis destroys transverse ligament

37
Q

Systemic Sx of RA?

A 
Episcleritis / scleritis / keratitis 
ILD 
Pericarditis / effusion 
Vasculitis 
Rheumatoid Nodules
38
Q

XR features of RA?

A

Joint space narrowing
Periarticular osteopenia
Errosive damage
Joint deformities

39
Q

If RA is suspected, how quickly do they get seen by rheumatology?

A

3 weeks

40
Q

Ix of RA?

A

CRP/ESR
Anti CCP
RF
USS / MRI / XR baseline

41
Q

What does RA predispose to?

A

Osteoporosis

42
Q

Mx of RA?

A

Analgesia
PRN antiinflammatories
IM steroids

43
Q

What are the disease modifying drugs for RA?

A

Methotrexate
TNF alpha blocker
Jakinibs

44
Q

List 4 types of spondyloarthritides

A

Axial spondyloarthritis
Psoriasis arthritis
Reactive arthritis
Enteropathic arthritis

45
Q

List common features of spondyloarthritides

A

HLA B27
Enthesitis
Arthritis

46
Q

What is enthesitis?

A

Inflammation of where soft tissue insert into bone

47
Q

What polymorphism is associated with spondyloarthritides ?

A

HLA B27

48
Q

What is the hallmark of spondyloarthritides?

A

Enthesitis

49
Q

List features of spondyloarthritides

A

Synovitis
Large joints
Some small joints
Dactylitis (swelling of whole digit)

50
Q

What rash do you get on soles of feet in reactive arthritis?

A

Keratoderma blenorrahgia

51
Q

Axial spondyloarthritides PC?

A

Male, <25

Inflammatory back pain insidious onset, pain at night, improves with exercise, worse with rest

52
Q

Test for Axial spondyloarthritides?

A

Schober’s test lumbar forward flexion

Thoracic expansion

53
Q

Imaging results for Axial spondyloarthritides?

A

Sacroilitis and shiny corner (enthesitis)

54
Q

Posture of Axial spondyloarthritides?

A

Question mark posture

55
Q

MRI findings of Axial spondyloarthritides?

A

Calcification of ligaments

Loss of joint space between vertebrae

56
Q

Psoriatic features?

A

Scaly skin rash on flexures
Psoriasis on scalp
Nail changes- pitting and onycholisis

57
Q

Reactive arthritis peripheral features?

A

Keratoderma blenorrhgagia (soles of feet and hands)
Conjunctivitis
Circinate balanitis

58
Q

What organisms can trigger reactive ?

A

Chlamydia

Salmonella, shigella, yersinia, campylobacter

59
Q

Who does enterohepatic arthritis affect?

A

IBD patients

60
Q

Ix for Axial spondyloarthritides?

A

HLA B27
CRP/ESR
Imaging - MRI
USS for peripheral joint inflammation

61
Q

Mx of Axial spondyloarthritides?

A 
Analgesia 
NSAIDs 
Steroids 
Methotrexate 
TNF alpha blocker 
Jakinibs
62
Q

Which drugs are disease modifying in Axial spondyloarthritides?

A

Methotrexate
TNF alpha blocker
Jackinibs

Lottie's DPD 2 (10 decks)

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